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home - Stomach - Obesity Surgery - Obesity Surgery Criteria Written by Dr Sebastian Zeki
Knowledge


Describes the risks associated with obesity
Describes the dietary, pharmacological and surgical techniques
(including anatomical re-configuration) for managing obesity and their
associated medical and nutritional complications

Skills
Takes a relevant history and perform an appropriate examination in
order to be able to define level of obesity, identify potential
complications and arrange relevant investigations before referral to
an obesity service

Investigates and appropriately manages (in conjunction with surgical
and dietetic colleagues) patients admitted with complications from
bariatric surgery

Behaviours
Recognises obesity as an illness and will evaluate and treat the
patient in a sympathetic manner

Obesity Surgery Criteria

Advantages and disadvantages of RYGB compared to LAGB:-Weight loss at one year was superior (median difference 26 %) for RYGB.-Resolution of comorbidities, such as diabetes and dyslipidemia, was better for RYGB.-Operative times and length of hospitalization were longer for RYGB.-Perioperative complications (9 versus 5 %) were greater but reoperation rates (16 v.24 %) lower for RYGB.-Mortality was higher, although it was low in both groups (0.06 and 0.17 % for LAGB and RYGB, respectively). Contraindications for Bariatric Surgery:Untreated major depression or psychosis.Binge eating disorders.Current drug and alcohol abuse.Severe cardiac disease with prohibitive anesthetic risks.Severe coagulopathy, or inability to comply with nutritional requirements including life-long vitamin replacement.Bariatric surgery in advanced (above 65) or very young age (under 18) is controversial.Bariatric surgery needs to be performed in conjunction with a comprehensive follow-up plan consisting of nutritional, behavioral, and medical programs. Effectiveness of Bariatric Surgery Obesity Surgery Criteria Indications For Bariatric Surgery:Be well-informed and motivated.Have a BMI >40.Have acceptable risk for surgery.Have failed previous non-surgical weight loss.Adults with a BMI >35 who have serious comorbidities. Choosing a procedure Most common are laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB). -Thus, in this meta-analysis of predominantly observational studies, RYGB was associated with greater long-term success but higher short-term morbidity. 30-day mortality:0.1 % for purely restrictive procedures (defined below), 0.5 % for gastric bypass, 1.1 % for biliopancreatic diversion or duodenal switch.Resolution or Improvement Of Obesity Related ConditionsDiabetes: 86 %.Hyperlipidemia: 70 % Hypertension: 79 %.Obstructive sleep apnea: 84 %.Gastroesophageal reflux symptoms improve and complete or partial regression of Barrett's esophagus has been demonstrated.Type 2 diabetesResolution was highest after biliopancreatic diversion/duodenal switch (95 %) and lowest after laparoscopic adjustable gastric banding (57 %). Written by Dr Sebastian Zeki

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